小儿肺炎的病原学研究

Study on Etiology of Infantile Pneumonia

目的探讨本地区近期引起小儿肺炎的常见病原体和临床流行病学特征,以指导临床合理使用药物治疗。方法 423例确诊为肺炎的患儿均作痰液细菌培养、间接凝集试验检测肺炎支原体(MP)和肺炎衣原体(CP)血清IgM抗体、免疫层析法测定常见5种呼吸道病毒血清IgM抗体。结果 423例患儿中,检出明确病原者181例(42.79%)。痰细菌培养阳性102例(24.11%),其中肺炎链球菌44例(10.40%)、金黄色葡萄球菌15例(3.55%)、肺炎克雷伯氏菌11例(2.60%)、大肠埃希氏菌9例(2.13%)、阴沟肠杆菌7例(1.65%)、铜绿假单孢菌6例(1.42%);真菌阳性7例(1.65%)。MP IgM阳性39例(9.22%);CP IgM阳性0例。病毒IgM检测阳性共45例(10.64%),其中柯萨奇病毒(CBV)23例(5.44%)、呼吸道合胞病毒(RSV)18例(4.26%)、单纯疱疹病毒(HSV)12例(2.84%)、EB病毒(EBV)8例(1.89%)、腺病毒(ADV)2例(0.47%),病毒混合感染18例。结论细菌仍是小儿肺炎的主要病原,其中肺炎链球菌最为常见,病毒感染以CBV多见,其次是RSV。革兰氏阴性菌感染主要见于1岁以内的小婴儿,罕见于6岁以上的儿童,MP则是6岁以上儿童肺炎的主要病原,CP感染各年龄段均未检出。

Objective To explore the common pathogens recently causing infantile pneumonia and the clinical epidemiological characteristics in the region,guide the rational use of drugs. Methods 423 children diagnosed as pneumonia were enrolled in this study,and sputum culture was used for the diagnosis of bacterial pneumonia; indirect agglutination test for detecting serum IgM antibodies of Mycoplasma pneumoniae （MP） and Chlamydia pneumoniae （CP） ; immune chromatography method for determine serum IgM of 5 common respiratory viruses. Results In all 423 cases, a clear pathogens were found in 181 （42.79%） ; sputum culture was positive in 102 cases（ 24.11% ）, of which Streptococcus pneumoniae in 44 cases （10.40%）, Staphylococcus aureus in 15 cases （ 3.55 % ）, Klebsiella pneumoniae in 11 cases （ 2.60% ）, Escherichia coli bacteria in 9 cases （2.13%）, Enterobacter cloacae in 7 cases（ 1.65% ） ,Pseudomonas aeruginosa in 6 cases（ 1.42% ） ;positive fungi in 7 cases（ 1.65% ）. MP IgM was positive in 39 cases（9.22% ） ;CP IgM was negative in all cases. Virus IgM were positive in 45 cases（ 10.64% ） ,and Coxsackie virus（CBV） in 23 cases（5.44% ） ,respiratory syncytial virus（RSV） in 18 cases（4.26% ） ,herpes simplex virus（HSV） in 12 cases （ 2.84 % ）, E B virus （ EBV ） in 8 cases （ 1.89 % ） , adenovirus （ADV） in 2 cases （ 0.47 % ）, mixed infection with different viruses in 18 cases. Conclusion The bacteria are still the leading cause of pneumonia in children, Streptococcus pneumoniae is the most common pathogens. Viral infection with CBV is more common, and followed by RSV. The negative Gram bacterial infection occurs mainly in young infants less than 1 year old ,and rarely in children over 6 years ,MP is the leading cause of pneumonia in children over 6 years, CP infection were not detected in all ages.